Pre conception folic acid

For years, we have been encouraging women to take folic acid, or folate, while they are trying to conceive and  through the first trimester of pregnancy.

Folic acid helps cells to divide and grow. In this way,the vitamin will help the spine fuse properly during embryo development. Since the widespread supplementation of  folic acid to our diet, the worldwide incidence of spina bifida in babies has plunged dramatically. This is a good thing.

But recently, researchers wondered if enhanced cellular-division-and-growing might have unintended consequences. What if the folic acid encouraged other cells to grow too?

In fact, we already know that folic acid does just that: women with breast cancer should not be taking high doses of folic acid, for fear that it will exacerbate the disease. And recently, in rat studies, researchers have suggested that folic acid can increase the risk of breast cancer in offspring too. (See this Globe and Mail article for an accessible summary).

So what should you do? Should you be taking folic acid to increase the chances for having a healthy baby, or not?

The challenge of medicine today is that we often have one part of the story without the other. In this case, we have one study involving rats, but what we really want to know is how much of this new information applies to you.

The Society of Obstetrics and Gynecology of Canada will have an opinion one day, but the very nature of committee work implies that it may be a long time before they provide guidance. My advice is to look to Motherisk.

The latest guidelines were presented in 2008. The guidelines are clear: we should be encouraging folic acid supplementation.

I am going to continue to follow the 2008 guidelines for now, but I’m also going to remain alert to what Dr Gideon Koren has to say on the subject. If through a lecture or personal communication I have an update for you, I will be sure to post it here.

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